Organisational culture and its influence on physicians’ consultation style in Hong Kong

Chronic diseases are considered to be a global health system challenge, contributing to 60% of all deaths worldwide in 2005. There is a recognised need for patients with chronic diseases to make regular medication decisions with their GPs as an essential part of consultations. A growing body of evidence from the UK, the United States and China has suggested a link between GPs’ involvement of patients and information sharing in treatment decisions and improved communication and clinical performance. Charles and colleagues (1999) proposed a continuum of consultation models with increasing patient engagement, the one-way GP-dominant “paternalistic” style, the two-way “shared decision-making” (SDM) style, and the one-way patient-dominant “informed” style. These models illustrate various levels of involvement and knowledge sharing between GPs and patients in the treatment decision-making process. Yet, there is a lack of evidence to determine how organisational culture drives different consultation styles and improves decisional communication in Asian countries. Therefore, this qualitative study explored GPs and primary care managers’ perceptions of organisational culture within public and private healthcare organisations in Hong Kong, and how these perceptions influence GPs’ consultation style during medication consultations with patients with chronic diseases. Themes were generated from in-depth individual interviews with fourteen GPs and five primary care managers, based on two analytical frameworks, the Hofstede cultural dimension theory (2001/2011) and Hofstede’s multi-focus model of organisational culture (1990). Four themes concerning national culture, organisational culture, the system-, practice- and individual factors, as well as the financing and service level initiatives to drive cultural changes, were identified as influencing GPs’ consultation styles. The study highlighted that an engaging management style and customer-focused and mandatory learning cultures within healthcare organisations promoted greater use of two-way consultation styles by GPs during the consultation. In contrast, the study also found that authoritative, profit-driven and voluntary learning cultures within healthcare organisations promoted more one-way consultation styles, such as the paternalistic or informed styles. Thus, this study contributes to a better understanding of the positive and negative influences of national and organisational cultures on GPs’ practice of SDM with patients in discussions of chronic disease management across public and private healthcare organisations in an Eastern Asian country. Further research on the national culture of health care financing and patients’ influences on consultation styles is needed before the association between organisational culture and consultation style can be comprehensively understood

Urban Acupuncture in Taipei

A number of conditions can be attributed to driving the recent revolutionary movement of urban acupuncture and locally-led interventions in cities around the world. Political, economic, and environmental uncertainty; the deindustrialization of cities that has led to an increase in vacant lots and buildings; and an increasingly mobile workforce all support the desire for more flexible and adaptable spaces and uses (Bishop and Williams, 2012). The inefficiency of institutional bureaucracy has also been identified as a contributing factor as to why citizens are taking local improvements into their own hands. These all lead to an increasing awareness that traditional planning processes are struggling in its capacity to be adaptable and resilient enough to respond to local needs. The rising sense of responsibility among citizens who actively partake in responding to local situations, separate from traditional planning processes such as attending planning consultations or sitting on community boards and commissions, reflect the discrepancy between contemporary planning processes and its adequacy in engaging stakeholders and addressing local issues. Temporary interventions have emerged as a gateway for improvements to local neighbourhoods in a more timely, efficient, and less costly and risky manner. These informal initiatives are popularly known as "urban acupuncture". In the context of Taipei, urban acupuncture is a city leading in its local transformative capacity where people-centric planning is implemented on a governmental level. Urban acupuncture is put into practice by the Taipei City Government through an apparatus called ?Urban Regeneration Station (URS)? to promote local development through the strength of local communities. URS sites are shared by all citizens - even throughout the innovative progress is public participation the main priority. Creativity, art, culture and design are integrated into the practice of urban regeneration as a catalyst of urban redevelopment. This thesis purports that urban acupuncture has a particularly important role in the future of cities and its communities because it challenges the assumption that cities can improve only through major spending and tortuous rounds of paperwork and approvals. It allows citizens and officials to test new ideas on a low-cost, low-risk model. If something works, great. If it doesn?t, well, on to the next experimental idea. Drawing upon the metaphor of therapeutic acupuncture, examples will be explored to highlight ways in which punctual interventions can activate places, asserting the importance of urban acupuncture in facilitating more holistic understandings of urban health

In vivo facial tissue depth study of Chinese-Americans in New York City

Facial tissue depth measurements are used to create forensic facial reconstructions to aid in human remains identification. Collection of such measurements began in the late nineteenth century with anatomists His, Kollman, and Welcker. Their results were used to bring the rich and famous back to life. In the 1970s, the technique of facial reconstruction was revitalized and incorporated into the forensic science field to aid in human identification. However, certain populations are extremely under-represented. This study collected facial tissue depth information from the adult Chinese-American population in New York City. The study sample included 101 adult Chinese-Americans of varying weights and ages residing in New York City. Following the procedure outlined in Manhein et al. (2000), ultrasonic measurements were taken at 19 landmarks on the face. Previously used datasets to represent Chinese-American facial tissue depth (especially Miyasaka 1998; Ogawa 1960; Suzuki 1948) are compared to these data. This thesis examines how the Chinese-American facial tissue depth data compare with other Mongoloid, Manhein et al.\u27s (2000), and Kollman and Buchly\u27s datasets. As expected, this dataset showed that facial tissue depths in Chinese-Americans were thicker than those of their Japanese counterparts (as represented in Suzuki 1948). In this dataset, statistical tests show that Body Mass Index (BMI) was the strongest determinant of facial tissue depth, while sex and age were the weakest. The results of this study provide valuable facial tissue depth information for a previously under-represented population. Forensic facial reconstructions for Chinese-Americans using this dataset will be more accurate and will increase the chances of positive identification. Further studies would need to be conducted in order to understand the relationship between age, sex, BMI, and facial tissue depth

Synthesis, characterisation and application of novel quinones for the detection of latent fingermarks

University of Technology Sydney. Faculty of Science.Identification of an individual through fingermarks is one of the oldest types of evidence in forensic science. A number of techniques are available for the detection of latent fingermarks on porous surfaces; for example 1,2‐indanedione zinc (IND‐Zn), 1,8‐diazafluoren‐9‐one (DFO), and ninhydrin. While these techniques produce excellent results, each has their drawbacks. For example, ninhydrin requires secondary post-treatment and cooling with liquid nitrogen to produce fluorescent fingermarks. DFO developed fingermarks are difficult to detect on coloured or highly patterned surfaces. IND‐Zn produces a highly fluorescent fingermark, however, under white light little contrast exists between the fingermark and the substrate. Therefore, there is need for research into the development of new fingermark reagents. Quinones have been used for the development of amino acids in chromatography and biochemistry. Recent research into the use of 2‐hydroxy‐1,4‐naphthoquinone (lawsone) has shown promising results for the development of latent fingermarks on porous surfaces. One of the aims of this thesis was to determine the reaction products between lawsone and three amino acids. These products were elucidated using Fourier transform infrared (FTIR) spectroscopy, nuclear magnetic resonance (NMR) spectroscopy and quadrupole time‐of‐flight liquid chromatography‐mass spectrometry (LC‐QTOF‐MS). The proposed product is hypothesised to be similar between benzoquinones, naphthoquinones and anthraquinones as they differ only by π conjugation. Another aim of this thesis was to synthesise a variety of quinones with differences in conjugation and substitution in order to compare and determine differences in quantum yield and whether these effects would influence their ability to develop latent fingermarks on porous surfaces. A number of quinones were successfully synthesised and characterised using FTIR and NMR spectroscopy and LC‐MS. In this preliminary study, the synthesised quinones and lawsone were then evaluated as potential reagents for the development of latent fingermarks on porous surfaces. The development conditions, reagent concentration, solvent system, pH, and metal salts enhancements of each quinone were optimised using amino acids and fingermarks on different porous surfaces. All the quinones that were tested in this thesis did not produce coloured fingermarks and only developed faintly coloured amino acid test strips. Slight improvements in luminescence were observed when comparing the results of the amino acids and fingermarks developed by naphthoquinones and anthraquinones. This is this is likely due to steric hindrance preventing anthraquinones from forming the desired products. Comparisons were also made between the fingermarks developed by the synthesised compounds and IND‐Zn, with IND‐Zn developed fingermarks being far superior in luminescence

Anorexic Eating: Two Case Studies in Hong Kong

Little attention has been paid to the eating experience of anorectic females during the course of their illness. In order to enrich this understanding, two adult anorexics were selected and their emails were collected and analyzed. Analysis of these emails reveals the patients\u27 experiences with and feelings about eating, which can provide an in-depth understanding of their circumstances and family dynamics. The paper ends with a discussion of the results, limitations, and implications of using emails as the data source of a qualitative study, and how they can reveal the informants\u27 inner landscapes

Through the Lens of Postmodernism: Uniqueness of the Anorectic Families

This paper challenges the monolithic assumption of the anorectic families in Hong Kong by blindly adopting the western theoretical framework of family therapy. It is problematic that family therapy lacks indigenous culture-specific knowledge and ignores the voices of these multi-categories of families. It is inappropriate to conceptualize these families as being similar and to stereotype them as experiencing particular difficulties. In order to bridge the homogeneity and address the multiplicity of these families, the paper examines both the ideologies of postmodernism and the process of confession that can enrich the understanding of anorectic families and advance family practice. The paper ends by discussing both reservations and the significance of the postmodernist thought in family therapy

Novel Strategies For Glutamate Clearance in the Glia-Deprived Synaptic Hub of \u3ci\u3eC. elegans\u3c/i\u3e

As the major excitatory neurotransmitter in the mammalian brain, Glutamate (Glu) is critical for normal neuronal physiology. Disruption in Glu clearance results in hyper-stimulation of glutamatergic circuits, potentially leading to excitotoxic neurodegeneration. The canonical model of brain connectivity describes glutamatergic synapses as well insulated and enveloped by glia. These glia express Glu Transporters (GluTs) which work to clear Glu following synaptic activity. However, critical areas of the brain such as the mammalian hippocampus display poor synaptic isolation, which may result in Glu spillover between adjacent synapses and subsequent loss of circuit specificity. How accurate signal transmission is achieved in these glia-deprived areas remains unclear. We approach this question using the C. elegans system, which faces the same dilemma as the mammalian hippocampus. Using a combination of behavioral assays and imaging of transgenic animals expressing Ca2+-sensitive reporter GCaMP or Glu-sensitive reporter iGluSnFR, we demonstrate a combined role of synaptic location and pharyngeal pulsatility in efficient Glu clearance of the nerve ring. We find that perfusion of Glu-rich interstitial fluid plays a vital role in GluT-mediated synaptic clearance, shown in our experiments where we induce paralysis of pharyngeal and head muscles to inhibit local movement. This study provides novel insights to mechanisms of effective Glu clearance in the absence of glia, a feature shared between nematodes and vital areas of the mammalian brain. Investigating novel mechanisms of Glu clearance can inform us in seeking candidate targets for therapeutic interventions in brain ischemia, and potential ways of manipulating brain pulsations and heart rate to promote clearance of solutes and aggregates (such as amyloid β) in patients to slow the onset of Alzheimer’s disease and other neuropathies

The Secrets of Self-Starvation

This is a single case study for which a life history approach was adopted. The informant, a patient suffering from anorexia nervosa (AN), was specifically selected because of her particular circumstances. Three themes emerged from her narrative that accounted for self-starvation: saving money, reserving food and competing for slenderness. The paper explores these themes and closes by emphasizing the necessity of understanding the sensitive and untold story of a patient’s self-starvation in her cultural-familial context